Salivary gland immunoglobulin and rheumatoid factor synthesis in Sjögren's syndrome: Natural history and response to treatment

Abstract Labial salivary glands, like the major salivary glands, are infiltrated with lymphoid cells in Sjogren's syndrome (SS). Studies utilizing biopsy specimens from the lower lips of seventy-six patients, forty-one of whom had Sjogren's syndrome, demonstrated that local synthesis of large amounts of immunoglobulins (IgM and IgG) and rheumatoid factor in salivary glandular tissue is distinctive for Sjogren's syndrome. The presence of rheumatoid factor was demonstrated autoradiographically by interaction between anti-lgG:lgG complexes and labeled immunoglobulins. Rheumatoid factor in the lip was found in eighteen of forty-one (43 per cent) patients with Sjogren's syndrome and in only two of thirty-five (6 per cent) control patients. On repeat biopsy of the lip untreated patients showed progression of lymphoid infiltration and increased immunoglobulin synthesis, whereas two patients treated with cyclophosphamide showed improvement histologically and all treated patients had diminished immunoglobulin synthesis. Sicca symptoms diminished in five of ten patients who were treated with cyclophosphamide for serious complications or other associated diseases, but immunosuppressive therapy cannot yet be recommended for uncomplicated Sjogren's syndrome.